Presurgical Sleep-Wake Disturbance and Postoperative Delirium: A Prospective Cohort Study

Prior studies on the relationship between presurgical sleep-wake disturbance and postoperative delirium have been restricted to subjective or indirect sleep measures. This study evaluated whether objective measures of presurgical sleep-wake disturbance are associated with postoperative delirium.

Prospective study.

Single site, tertiary care medical center.

Adults aged 40 years or older having surgical aortic valve replacement.

Before surgery, we assessed sleep using self-report, ambulatory polysomnography, and actigraphy. Other measures include sociodemographics, medical-surgical characteristics, and neuropsychological battery. After surgery, we assessed delirium and delirium severity.

The 100 participants had a mean age of 66.9 years (64% male). Twenty-seven subjects developed delirium. After adjusting for age, sex, comorbidity, and surgery duration, we found that each 10% decrease in presurgical sleep efficiency was associated with more than double the odds of delirium (OR 2.16, 95% CI [1.10, 3.71]), as was each 10% decrease in presurgical relative amplitude of rest-activity rhythms (2.59 [1.34, 5.23]). Lower sleep efficiency and relative amplitude were also associated with greater delirium severity (standardized |β| = 0.39 and 0.42, respectively). Apnea-hypopnea index ≥15 events/h was associated with higher odds of delirium (OR 3.4 [1.01, 11.7]) but not delirium severity. Mild cognitive impairment and lower global cognitive function were also associated with higher odds of delirium and greater delirium severity.

Lower presurgical sleep efficiency, apnea-hypopnea index ≥15 events/h, and weaker rest-activity rhythms were associated with a higher odd of postoperative delirium suggesting a potential role for targeting these sleep-wake disturbances to mitigate delirium.